Academic journal article European Journal of Psychotraumatology

An Evaluation of ICD-11 PTSD and Complex PTSD Criteria in a Sample of Adult Survivors of Childhood Institutional Abuse

Academic journal article European Journal of Psychotraumatology

An Evaluation of ICD-11 PTSD and Complex PTSD Criteria in a Sample of Adult Survivors of Childhood Institutional Abuse

Article excerpt


An evaluation of ICD-11 PTSD and complex PTSD criteria in a sample of adult survivors of childhood institutional abuse

Matthias Knefel and Brigitte Lueger-Schuster*

Faculty of Psychology, University of Vienna, Vienna, Austria


Background : The WHO recently launched the proposal for the 11th version of the International Classification of Diseases (ICD-11) that also includes two diagnoses related to traumatic stress. In contrast to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), ICD-11 will probably, in addition to posttraumatic stress disorder (PTSD), also define a new diagnosis termed "complex posttraumatic stress disorder" (CPTSD).

Objective : We aimed to apply the proposed ICD-11 criteria for PTSD and CPTSD and to compare their prevalence to the ICD-10 (International Classification of Diseases [10th revision]) PTSD prevalence. In addition, we compiled a list of symptoms for CPTSD based on subthreshold PTSD so as to include a wider group of individuals.

Methods : To evaluate the appropriateness of the WHO ICD-11 proposal compared to the criteria of ICD-10, we applied the newly introduced criteria for PTSD and CPTSD deriving from the Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C) and the Brief Symptom Inventory (BSI) scales, to a sample of adult survivors (N =229) of childhood institutional abuse. We evaluated the construct validity of CPTSD using confirmatory factor analysis (CFA).

Results : More individuals fulfilled the criteria for PTSD according to ICD-10 (52.8%) than the ICD-11 proposal (17% for PTSD only; 38.4% if combined with complex PTSD). The new version of PTSD neutralized the gender effects. The prevalence of CPTSD was 21.4%, and women had a significantly higher rate of CPTSD than men (40.4 and 15.8%, respectively). Those survivors who were diagnosed with CPTSD experienced institutional abuse for a longer time. CFA showed a strong model fit.

Conclusion : CPTSD is a highly relevant classification for individuals with complex trauma history, but surprisingly, effects of gender were apparent. Further research should thus address gender effects.

Keywords: ICD-11; posttraumatic stress disorder; complex PTSD; institutional abuse; gender

*Correspondence to: Brigitte Lueger-Schuster, Faculty of Psychology, University of Vienna, Liebiggasse 5, AT-1010 Vienna, Austria, Email:

For the abstract or full text in other languages, please see Supplementary files under Article Tools online

Received: 14 August 2013; Revised: 14 October 2013; Accepted: 18 October 2013; Published: 3 December 2013

European Journal of Psychotraumatology 2013. © 2013 Matthias Knefel and Brigitte Lueger-Schuster. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Citation: European Journal of Psychotraumatology 2013, 4 : 22608 -

The International Classification of Diseases (11th revision) (ICD-11) working group for mental disorders specifically associated with stress (Maercker et al., 2013) recently published a proposal for the ICD-11 criteria for posttraumatic stress disorder (PTSD). This proposal adopts a new diagnosis, termed "complex posttraumatic stress disorder" (CPTSD), that emphasizes clinical utility, in other words, consistency between diagnoses and clinicians' mental health taxonomies (Cloitre, Garvert, Brewin, Bryant, & Maercker, 2013). CPTSD was initially proposed by Judith Herman (1992), who stated that "In contrast to the circumscribed traumatic event, prolonged, repeated trauma can occur only when the victim is in a state of captivity, unable to flee, and under control of the perpetrators" (p. …

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